Nurul Sazwani
 Definition
: a state of negative fluid balance
 decreased intake
 increased output
 fluid shift
 appears
unwell
 altered responsiveness, for example is
irritable or lethargic
 decreased urine output
 pale or mottled skin
 cold extremities
 Headache, dizziness, fainting
 Orthostatic hypotension
 Thirst
 Loss of appetite, nausea
 paresthesia

Fast! Capillary refill -normal< 2s

Poor skin turgor
Hypotension
Tachycardia
Shock



Laboratory investigations:
 Do not routinely perform blood biochemistry.
 Measure plasma sodium, potassium, urea,
creatinine and glucose concentrations if:
–intravenous fluid therapy is required or
–there are symptoms or signs suggesting
hypernatraemia.
 Measure venous blood acid–base status and
chloride concentration if shock is suspected or
confirmed.
 Urine specific gravity
 Other tests may be done to determine the cause
of the dehydration (for example, blood sugar
level to check for diabetes).
Questions?
 1.Which method of rehydration?
 2.How
much fluid should patient receive?
 3.With
what speed should the fluids be
given?
 4.What
type of solution?
Basic
fluid need
+
Fluid lost
+
Extra fluid deficit
 Basic
fluid need:
Depends on the weight (/24 hours):
1-10kg –100 mL / kg
11-20 kg –50 mL / each kg > 10 kg
20-70 kg –20 mL / each kg > 20 kg
Over 70 -2500-3000mL /24 hours
How much fluid did the patient loose?
 Patients’ weight
 Assess according to the table:
up to 5%
6-10%
>10%
Extra fluid deficit
 •Vomitting
 •Diarrhoea
 •Fever
 •Tachypnoe
for each episode of vomitting/ loose stool/
degree of fever≥ 38°C add additional
10ml/kg/24 hours
 ORS
– Oral rehydration solution
 Milk?
Fruit juice? Sodas? Carbonated
beverages? Caffeinated drinks? Sports drinks?
If intravenous fluid therapy is required for
rehydration (and is not hypernatraemic at
presentation):
 use an isotonic solution such as 0.9% sodium
chloride, or 0.9% sodium chloride with 5%
glucose, for fluid deficit replacement and
maintenance
 speed of rehydration:
50% within the first 8 hours(bolus included)
50% within the remaining 16 hours
Suspect hypernatraemicdehydration if there
are any of the following:
 jittery movements
 increased muscle tone
 hyperreflexia
 convulsions
 drowsiness or coma.
If intravenous fluid therapy is required in
hypernatraemic dehydration:
 obtain urgent expert advice on fluid
manageme
 replace the fluid deficit slowly
- typically over 48 hours
 monitor the plasma sodium
frequently, aiming to reduce it at
a rate of less than
0.5 mmol/l per hour.
 Treat
suspected or confirmed shock with a
rapid intravenous infusion of 20 ml/kg of
0.9% sodium chloride solution.